Mid Back Pain

Trigger Points

A trigger point is a painful knot within a muscle. They develop for a variety of reasons including disc bulges, pinched nerves, postural imbalances, overuse, etc. The most effective treatment for a trigger point in the long term is to treat the root cause which is often a bulging disk and a pinched nerve. However, I see plenty trigger points in folks with otherwise healthy spines where some brief soft-tissue work and of electrical muscle stimulation are very effective treatments. What I usually tell folks is that a trigger point is probably just a trigger point unless it is reoccurring in which case it is probably coming from the spine.

Pain at the Rib Articulation
People often tell me that they have a "rib out" when trying to describe pain between the spine and the shoulder blade. Most of the time what they are feeling is a trigger point, a minor strain, or joint pain in the spine or where the rib attaches to the vertebra. Since we are constantly breathing, these joints do not have a fixed position. The joint between a rib and the spine is two fold and is primarily ligamentous allowing a lot of movement which is essential to respiration. These joints do not possess the same type of fluid and capsule that allows spinal facet joints to cavitate (pop) and are much less prone to dysfunction.
 

Thoracic Intervertebral Discs
While uncommon, disc bulges do occur in the thoracic spine. They can be very painful and just like in the low back or neck the prognosis is not great with likelihood of long term pain is high. Fortunately the rib cage and relative inflexibility of the thoracic spine puts it at a low right of disc problems. Treatment for disc problems in the thoracic spine generally consists of joint manipulation, electrical muscle stimulation, and home exercise.
 

Thoracic Facet Joints
The facet joints in the thoracic spine allow for flexion and extension but not a lot of lateral flexion or rotation. For this reason, most thoracic facet joint injuries occur with twisting and side bending. The facet joints, just like in the neck and low back, respond well to joint manipulation and are easily treatable with chiropractic care often only requiring a few visits before people are satisfied. Reoccurring facet joint pain in the thoracic spine may be a sign of underlying disc problems which can be easily identified with an MRI.


Thoracic Spinal Nerves
The highly sensitive spinal nerves exit the spine adjacent to the disc and the facet joints, both of which can aggravate the nerve and cause significant pain. Most of the time its not the nerve that is a problem but rather injuries or disease of the adjacent tissues. Nerve pain may be an indicator of the severity of disc or facet joint problems. Generally when the verve is affected the prognosis is poorer. In individuals who had the chicken pox growing up, the spinal nerves are prone to a shingles outbreak which can be exquisitely painful. unfortunately, there is not a lof that can be done by hand to treat shingles. 


Thoracic Spinal Musculature
just like anywhere else in the body, muscle strains account for a bulk of the movement related back injuries I see in practice. The shoulder blades provide attachment for 16 muscles on each side and there are multiple layers of muscles coursing the length of the spine, any of which may be injured by movements, falls, and even poor posture. The treatment of muscles is a lot more nuances that most people think which is why a massage may not always solve the problem. Depending of the degree of the injury and where it is in the healing process the treatments may be very different. One thing to remember is that scar tissue is not functional and may cause further problems down the line. This is why treating muscle injuries is just as important and treating spinal injuries. Treatment will vary ona case by case basis but generally electrical muscle stimulation, soft-tissue, stretching, and home exercise will do the trick.

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